The scintigraphic 99mTc-MAA imaging quantification of the right-to-left shunt in a patients with multiple pulmonary arteriovenous malformation and familial teleangiectasis

Česká verzia

Authors: J. Doležal
Authors place of work: Oddělení nukleární medicíny Lékařské fakulty UK a FN Hradec Králové, přednosta prim. MUDr. Ing. Jaroslav Vižďa
Published in the journal: Vnitř Lék 2008; 54(2): 206-209
Category: Case Report

Summary

Aim:
To present a case report about 57-years-old woman with hypoxemia, multiple pulmonary arteriovenous (AV) malformations and lips teleangiectasis where the right-to-left shunt quantification was assessed by means of whole body scintigraphy with^99mTc-labelled human macro-aggregated albumin (MAA).

Material and Method:
A 57-years-old woman underwent X-ray and bolus enhanced lung CT for dyspnoea, hypoxemia and cyanosis. A multiple intrapulmonary arteriovenous malformations were detected. The whole-body ^99mTc-MAA scintigraphy for the right-to-left shunt quantification was performed. The whole-body scintigraphy in anterior and posterior view was started after intravenous application of 185 MBq ^99mTc-MAA. The double-head gamma camera Infinia (General Electric Medical Systems - GE MS) with infrared body countouring and the large field of view was used. The Gamma camera was fitted with low-energy, high resolution, parallel-hole collimator. Images were evaluated by processing system Xeleris (GE MS).

Results:
The whole-body ^99mTc-MAA scintigraphy revealed significant R-L shunt and uptake of radiotracer in extrapulmonary organs (brain, kidney, spleen). The right-to-left shunt ratio was 36 %. The woman underwent successful percutaneous transcatheter microembolization treatment. After treatment the woman underwent the next ^99mTc-MAA whole-body scintigraphy and the R-L shunt ratio decreased to 17 %.

Conclusion:
The ^99mTc-MAA whole-body scintigraphy assessed the right-to-left shunt ratio and improved the management of patients with multiple intrapulmonary A-V malformations. The next ^99mTc-MAA scintigraphy after the percutaneous transcatheter microembolization of multiple intrapulmonary A-V malformations confirmed success of treatment.

Key words:
R-L shunt - multiple intrapulmonary arteriovenous malformations - whole-body ^99mTc-MAA scintigraphy

Zdroje

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